Is Your Hair Falling Out?

“I think my hair is falling out.” How many of us have whispered this under our breath? 80 million in the U.S. alone. According to the American Academy of Dermatology, approximately 30 million American women and 50 million American men are experiencing hair loss at any given time.

But what we refer to generally as “hair loss” actually encompasses a wide range of different issues, each with a different cause. And the only way to treat any individual case is to accurately identify the problem. “Hair loss is a symptom, not a diagnosis,” explains Paul McAndrews, MD, a Pasadena dermatologist who specializes in hair restoration.

In order to pinpoint what is causing a patient’s specific issue, McAndrews asks a series of questions.

1.) Is it true hair loss, or breakage?

Many of us think the problem is coming from the root, when really it’s a function of strands weakening and snapping over time. If your hair appears thicker at the scalp than at the ends, you’re probably dealing with breakage. This can result from chemical processes (such as color and straightening), environmental exposure (sun, wind, water)—and even just dryness.

To keep strands strong, especially if you have (or want) long hair, McAndrews recommends choosing shampoos, conditioners and styling products designed for dry or damaged hair (look for the word “moisturizing” on the label). These will lubricate the hair shaft and prevent strand-to-strand friction, which leads to fraying—think of a sailor’s rope—and ultimately breakage.

2.) Have you noticed shedding?

If you’ve noticed excessive shedding and visible bulbs on what’s collected in your hairbrush, you’re most likely experiencing either telogen or anagen effluvium. Telogen effluvium, by far the most common variety of scalp disorder, occurs when a higher-than-normal number of hair follicles go into the resting stage all at once. This can be caused by a number of factors, from health issues, to medications, to nutrition, and is usually reversible. Anagen effluvium is when hairs in the growth phase fall out, and it results from exposure to poisons (including chemotherapy) and radiation. As long as there is no scarring, this kind of hair loss is also usually reversible.

Diffuse hair loss can also result from inflammatory auto-immune conditions such as hypothyroidism, lupus, and alopecia areata. These can be treated with steroids.

3.) Does it seem to be getting worse over time?

If you’ve noticed your hair getting thinner, but you haven’t experienced shedding or breakage, you’re probably one of the millions dealing with the most common cause of hair loss: androgenetic alopecia.

Androgenetic alopecia, more commonly referred to as “male (or female) pattern baldness" is a genetic condition—not a disease—that progresses as we age. It causes the diameter of individual hairs to become smaller and smaller over time, so eventually they appear almost invisible.

Although a diagnosis can feel devastating, androgenetic alopecia is actually quite easy to manage. The goal of treatments for both men and women with androgenetic alopecia is to block DHT, a hormone that causes genetically predisposed hair follicles to miniaturize over time.

Men and pre-menopausal women (although not those who are pregnant) can take finasteride (brand name Propecia), an oral prescription medicine that keeps DHT from damaging hair follicles. Those who prefer a topical, rather than systemic, treatment can opt for minoxidil (brand name Rogaine), which is applied directly to the scalp. Another option for women, but not men, is the oral blood pressure medicine Spironolactone, which also blocks DHT. An added bonus: it may banish other beauty nuisances caused by male hormones, from acne to unwanted facial hair.